vNOTES (vaginal natural orifice transluminal surgery) gynecologic procedures in morbidly and super-morbidly obese women: five year experience.

PURPOSE: To analyze our experience with vNOTES gynecologic procedures in women with morbid and super morbid obesity to determine feasibility and compare outcomes with standard minimally invasive techniques. METHODS: Gynecologic procedures performed by three surgeons on women with a body mass index (BMI) ≥ 40 kg/m2 from 2017 to 2023. A subset of women with a BMI ≥ 50 kg/m2 was also analyzed. RESULTS: 103 women with a BMI ≥ 40 kg/m2 were identified (Class IV), 19 of whom had a BMI ≥ 50 kg/m2 (Class V). For the entire population the mean BMI was 45.7 kg/m2 (40-62). 29 women were nulliparous and 23 had at least one prior cesarean delivery. 51 had no prior abdominal surgery. The procedures performed were hysterectomy and removal of adnexae in 77 patients, hysterectomy alone in six, adnexal surgery alone in nine, and hysterectomy with adnexectomy and lymph nodes in five. Two surgeries were converted to laparoscopy and five to laparotomy. Average surgical time was 87 min (30-232). Average blood loss was 82 mL (10-400). Mean uterine weight was 206 g (29-2890). 53 procedures were performed as outpatient, 44 had overnight observation, four had a length of stay of 2 days, one each for 4 days and 5 days. The laparoscopies occurred in one patient with an obliterated cul-de-sac and in one patient for lymph node removal. The laparotomies occurred for adnexal adhesions in one, bleeding in two, a cystotomy in one requiring urology consultation, and an obliterated cul-de-sac One patient developed a postoperative vaginal cuff hematoma not requiring intervention. CONCLUSION: vNOTES gynecologic procedures are feasible in this high-risk population and may result in shorter recovery times and fewer complications than standard laparoscopy or transvaginal surgery. What does this study add to the clinical work: VNOTES approach is feasible in morbidly obese women and may have distinct advantages over conventional laparoscopic, vaginal or open techniques.

Cost comparison of gynecologic procedures between the US and a developing country: an observational study.

The Unites States spends on healthcare, with women's health being included, more than what middle-to-low-income countries, such as Lebanon, do. Compared to the United States, Lebanon has negligible data on the amounts spent on healthcare including female health services. In this study, we try to assess the cost differences of common gynecologic procedures between Lebanon and the United States, trying to fill the gap of missing data in Lebanon and identifying potential factors that can lead to high healthcare cost in the United States. Retrospective chart review. Chart review in Lebanon and surgery cost estimate in the US. A total of 505 patients was included in Lebanon, where patients were divided into 3 classes of insurance depending on the services provided. Cost of common gynecologic procedures in US dollars. The data collected were stratified according to insurance statuses of the patients. Using the ANOVA test, a comparison was performed between different insurance categories of patients in the US and patients in Lebanon. Forty percent of Lebanese patients were covered by second-class insurance. Total abdominal hysterectomy with removal of corpus and cervix was the most common gynecologic procedure. In addition, there was a significant difference in the mean total bill between first-class and third-class insured patients. When comparing Lebanon to the United States, the mean total bill was significantly higher for insured and non-insured United States patients than patients in Lebanon, except for open myomectomy where the difference between the mean total bill in Lebanon and the United States was nonsignificant. There is a significant difference in the cost of Cesarean delivery, sub-classes of hysterectomy, and laparoscopic myomectomy between Lebanon and the United States, even when patients are classified according to their insurance status, which necessitates interventions in the United States to cut down costs.

A comparison of the efficacy of single-dose Cefazolin versus single-dose Cefazolin plus 7-day Mupirocin ointment wound application in preventing surgical site infection among patients undergoing major Obstetric and Gynecologic procedures at a tertiary university hospital: A single-blinded, randomized controlled trial / Philippine Journal of Obstetrics and Gynecology

Background@#Surgical site infection (SSI) is a common complication among all surgical cases. It is the most common nosocomial infection identified in the developing world with pooled incidence of 11.8 per 100 surgical procedures. In our institution, the SSI rate in major obstetric and gynecologic cases in years 2000–2013 is 12.68%. @*Objective@#To compare the efficacy of a single-dose cefazolin versus a single dose cefazolin plus 7-day mupirocin ointment wound application in preventing SSI among women undergoing major obstetric and gynecologic abdominal surgical procedures.@*Materials and Methods@#The study included are 164 female participants, aged 18–65 years old who underwent major obstetric and gynecologic surgical procedures. Participants were randomly assigned to Groups A and B, wherein all participants were given single dose of 2 g cefazolin, intravenous, 30 min before skin incision. For the participants in Group B, an additional 7-day application of mupirocin ointment on incisional wound during the postoperative period was given. Assessment for occurrence of SSI and healing time using a standardized collection tool and Southampton wound scoring system, respectively, was done on the 8th, 15th, and 30th postoperative days. @*Results@#The incidence of SSI is 2.45% (4 out of 164 participants). It was slightly higher in the Cefazolin only arm having three cases, while only one case in the Cefazolin plus mupirocin group. However, the difference of SSI occurrence between the two groups is not statistically significant. Wound healing time was also evaluated which was comparable between treatment groups.@*Conclusion@#Single dose Cefazolin plus 7-day once daily Mupirocin ointment application is comparable to single dose of cefazolin in preventing SSI in patients undergoing major low-risk obstetric and gynecologic surgeries. Therefore, the addition of mupirocin in uncomplicated major obstetric and gynecologic surgical cases is not cost-beneficial.

Electrosurgery and clinical applications of electrosurgical devices in gynecologic procedures.

Background: Electrosurgery is widely used in reproductive related surgeries and technological advancements to improve efficacy and reduce potential complications. However, some reports have indicated lack of sufficient knowledge and training about basic principles and technical aspects of electrosurgery among obstetricians and gynecologists. Methods: In this paper we present a summary on basic concepts and principles of electrosurgery and review the recent evidence on the use of electrosurgical devices in gynecologic procedures including endometrial ablation, gynecologic malignancies, loop electrode excision procedure (LEEP), and infertility. Result: Considering the extensive use of these technologies in reproductive related surgeries, procedures including laparoscopy, hysteroscopy, and loop procedures further highlights the importance of more detailed training in this field. Gynecologists must learn the basics in more detail and update their knowledge on the growing body of evidence regarding the advancements of these technologies to reduce potential complications and select the most cost-effective treatment options for each patient. Conclusion: Try to understanding the underlying biophysical principles and more in-depth familiarity with various electrosurgical devices could lead to less complications and optimize evidence-based gynecological practice.

Risk factors analysis of venous thromboembolism in post-operative patients with gynecological malignant tumor and application of related risk assessment table / 第二军医大学学报

Objective To investigate the risk factors of venous thromboembolism (VTE) ln post-operative patients with gynecological malignant tumors, and to evaluate the value of Risk Assessment Table of VTE in Hospitalized Patients in above patients. Methods A total of 530 post-operative patients with gynecological malignant tumors in our hospital between Oct 2010 and Nov. 2015 were enrolled, including 58 cases complicated with VTE and 472 cases without VTE. Clinical lndexesof all patients including age, body mass lndex (BMI), tumor type, tumor stage, operationmethod, operation time, amount of bleeding, history of blood transfusion, bedridden time, andhistory of comorbidities were statistically analyzed. The clinical dynamic evaluation of 317 post-operative patients with gynecological malignant tumor diagnosed between Nov. 2015 and Apr. 2017 were conducted by the new version of Risk Assessment Table of VTE inHospitalized Patients, which was jointly developed by our hospital. Targeted interventions were used based on the evaluation results, and the incidence of VTE was observed and compared with patients who did not use the assessment table. Results Univariate analysis results showed that BMI, tumor stage, operation time, amount of bleeding, blood transfusion and bedridden time were significantly related toVTE (P<0. 05). Multivariate analysis results showed that age, BMI, tumor stage, operation time and operation method were independent risk factors of VTE in post-operative patients with gynecological malignant tumor (P〈0. 05). After application of the Risk Assessment Table of VTE in Hospitalized Patients and taking corresponding interventions, the incidence of VTE in patients was significantly lower than that before application (1. 89% [6/317] vs 10. 9% [58/530], P〈0. 05). Conclusion Age, BMI, tumor stage, operation time and operation method are the independent risk factors of VTE in post-operative patients with gynecological malignant tumor. Assessing the risk of VTE in the peri-operative period and taking appropriate preventive measures according to the risk score can reduce the incidence of VTE in post-operative patients with gynecological malignancies.

Reimbursement for office-based gynecologic procedures.

Reimbursement for office-based gynecologic procedures varies with the contractual obligations that the physician has with the payers involved with the care of the particular patient. The payers may be patients without health insurance coverage (self-pay) or patients with third-party health insurance coverage, such as an employer-based commercial insurance carrier or a government program (eg, Medicare [federal] or Medicaid [state based]). This article discusses the reimbursement for office-based gynecologic procedures by third-party payers.

Robotic-assisted gynecologic/oncologic surgery: experience of early cases in a Saudi Arabian tertiary care facility.

We report early experience of a case-mix series of robotic-assisted (RA) gynecologic/oncologic surgery in an Arabian population from a tertiary care facility, and discuss the emergence/growth of robotic surgery in the Arab world (Middle East). From December 2005 to December 2010, 60 consecutive patients [benign with complex pathology (BN, n = 34) and 26 cases with various malignancies; i.e., endometrial cancer (EC, n = 13), ovarian cancer (OC, n = 4), cervical cancer (CC, n = 1), and other cancers (OTH, n = 8), underwent RA procedures for the diagnosis/treatment/management of gynecologic/oncologic diseases at a single institution using the da Vinci(®) Surgical System. Data were analyzed for demographics, clinico-pathologic and peri/post-operative factors using intent-to-treat analysis. Despite continuous growth in the number of cases performed each year, the establishment of the robotic surgery program at our institution has been rather challenging due to patient acceptance, public awareness, and administrative resistance. The mean age of the case-mix was 43 ± 15 years (distribution: BN 39 ± 14, EC 61 ± 6, OC 36 ± 15, CC 50, OTH 41 ± 12 years). The body mass index for the case-mix was 30.3 ± 6.9 kg/m(2) (distribution: BN 29.7 ± 6.2, EC 34.0 ± 3.6, OC 20.0 ± 1.7, CC 48, OTH 30.2 ± 6.2 kg/m(2)). The histology of most EC cases was endometrioid adenocarcinoma. The mean operative time was case-mix 95 ± 43, BN 77 ± 26, EC 156 ± 30, OC 80 ± 35, CC 150, OTH 79 ± 23 min. Mean blood loss was case-mix 126, BN 129, EC 177, OC 67, CC 50, OTH 71 min. Two cases (3.3%) were converted to laparotomy (one each in EC and BN groups). Mean hospital length of stay was 2 days. Four cases (6.7%) experienced complications. Only 4/26 (15.4%) of cancer cases required adjuvant therapy. The data suggest that RA gynecologic/oncologic procedures are feasible and satisfactory to our Arabian patient population and comparable to the existing literature for Caucasian counterparts. We believe this report is the first (and perhaps largest) case-mix series on the early experience of RA surgery for gynecologic/oncologic cases from the Middle East.

The Minailo knot: a time-saving and cost-saving technique.

Endoscopic knot tying during minimally invasive surgery can be complicated, time consuming, and associated with a protracted learning curve. The Minailo knot seems to be a reasonable option because the technique does not require any specialized instrumentation or skill to perform. In particular, vaginal closure is obtained with the placement of a single intra-corporeal knot. Our initial and successful experience with this knot-tying technique during robotic hysterectomy for treatment of gynecologic disease suggests that the method is safe and feasible.

Unscheduled vaginal bleeding and associated gynecologic care in postmenopausal women using hormone replacement therapy: comparison of cyclic versus continuous combined regimen / 대한산부인과학회잡지

OBJECTIVE: To measure gynecologic resources required to care for women who have unscheduled vaginal bleeding while using hormone replacement therapy. MATERIALS AND METHODS: Between January 1996 to December 1998, women presenting with abnormal withdrawal bleeding on HRT were identified and associated clinic visits and gynecologic procedures were recorded during a mean follow-up of 2 years. RESULTS: Among women using cyclic HRT, 28.9% had> OR =1 visit for unscheduled vaginal bleeding 8.7% had> OR =1 endometrial biopsy. Among women using continuous combined HRT, 19.3% had> OR =1 visit for unscheduled vaginal bleeding and 6.4% had> OR =1 endometrial biopsy. The gynecologic procedures used in women using cyclic HRT were 20% of reassurance, 50% of ultrasonograpy, 30% of endometrial biopsy and in women using continuous combined HRT were 50% of reassurance, 16.6% of ultrasonograpy, 33.3% of endometrial biopsy. The results of endometrial biopsy were reported all the benign condition. CONCLUSION(S): Unscheduled vaginal bleeding markedly decreased after 12 months of therapy in women using continuous combined HRT but did not decline among those using cyclic HRT.